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<table width="100%" height="600" border="1" cellpadding="0" cellspacing="0" bgcolor="#000000">
  <tr>
    <td colspan="5"><center> <b> ASSESSMENTS: </b></center> </td>
    </tr>
  <tr>
    <td width="291" bgcolor="#000000"><center class="style1"><font color="#FFFFFF">LOCAL TAXES</font></center>      </td>
    <td width="160" bgcolor="#000000"><center class="style1"><font color="#FFFFFF">REFERENCE </font></center></td>
    <td width="144" bgcolor="#000000"><center class="style1"><font color="#FFFFFF">AMOUNT DUE</font> </center>      
      </td>
    <td width="174" bgcolor="#000000"><center class="style1"><font color="#FFFFFF">PENALTY/SURCHARGE</font> </center>
     </td>
    <td width="169" bgcolor="#000000"><center class="style1"><font color="#FFFFFF">TOTAL ASSESSED BY</font></center>
      </td>
  </tr>
  <tr>
    <td><b>GROSS SALES TAX</b></td>

  </tr>
  <tr>
    <td>Tax on Delivery Vans/Trucks</td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="18" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
  </tr>
  <tr>
    <td>Tax on storage for combustible/flammable or explosive substance</td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="18" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
  </tr>
  <tr>
    <td>Tax on signboard/billboards</td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="18" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
  </tr>
  <tr>
    <td><B>REGULATORY FEES AND CHARGES</B></td>
  
    

  </tr>
  <tr>
    <td>MAYOR'S PERMIT FEE</td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="18" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
  </tr>
  <tr>
    <td>GARBAGE CHARGES</td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="18" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
  </tr>
  <tr>
    <td>Delivery Trucks/Vans Permit Fee</td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="18" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
  </tr>
  <tr>
    <td>SANITARY INSPECTION FEE</td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="18" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
  </tr>
  <tr>
    <td>BUILDING INSPECTION FEE</td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="18" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
  </tr>
  <tr>
    <td>Electrical Inspection Fee</td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="18" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
  </tr>
  <tr>
    <td>Mechanical Inspection Fee</td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="18" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
  </tr>
  <tr>
    <td>Plumbing Inspection Fee</td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="18" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
  </tr>
  <tr>
    <td>Signboard/Billboard Renewal Fee</td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="18" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
  </tr>
  <tr>
    <td>Signboard/Billboard Permit Fee</td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="18" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
  </tr>
  <tr>
    <td>Storage for combustible/flammable or explosive substance</td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="18" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
    <td><input name="DOA" type="text" value="" size="20" /></td>
  </tr>
  <tr>
    <td>Others:</td>
   <tr><td> Total
   </td></tr>   
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  
    
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